Obamacare open enrollment ends. Time for a checkup?

What reporters are asking now and where they should focus in the weeks and months ahead

Midnight Monday brought the end of Obamacare’s first open enrollment period, a deadline marked the next day by President Obama’s Rose Garden announcement touting 7.1 million insurance sign-ups to date. “The milestone,” as The New York Timesreported, “may be more significant politically than for what it says about the law’s potential impact on the American healthcare system.” A review of press coverage around Monday’s “milestone” identifies challenges for the law itself, for Americans who signed up for insurance, and for reporters continuing to work the story.

Although several news outlets discussed Obamacare’s starring role in the coming midterm election battles—The Washington Post, for example—many also picked up other angles, such as the issue of how to measure the success of the law (something I’ve written about). Pro Publica’s Charlie Ornstein examined various ways to judge success, like assessing whether states met Department of Health and Human Services enrollment estimates (made last fall). Ornstein’s piece concluded with comments from Kaiser Family Foundation president Drew Altman questioning whether the public will wait for all the facts before making up its mind. Altman also figured prominently in a New York Timespiece on Friday. “The whole narrative about Obamacare—‘Will they get to six million? What is the percentage of young adults going to be?’—has almost nothing to do with whether the law is working or not, whether the premiums are affordable or not, whether people think they are getting a good deal or not,” Altman told the Times. The question of whether enough young “invincibles” signed up to balance the insurance claims of older and sicker enrollees (if not, the law has provided for such a contingency) has indeed become somewhat of a media obsession.

Another common question in coverage: Will those big bad insurance companies raise their rates for the next round of open enrollment, which begins in November? Bloomberg reported, “Already, Indianapolis-based WellPoint Inc., the largest exchange insurer, has warned it may propose ‘double-digit’ premium increases for the next enrollment period.” Chad Terhune, the insurance reporter for the Los Angeles Times, broadened the insurance angle and WellPoint’s warning, sharing with his readers how actuaries at California Blue Shield make judgments about premium rates.

A few outlets looked at obstacles the newly insured will face. A story by Tony Pugh of McClatchy’s Washington Bureau featured a recently released study in the health policy journal Health Affairs which noted that about half of those with subsidized coverage from the exchanges and about half of new Medicaid recipients are likely to lose coverage within a year for a variety of reasons (divorce, births, deaths, changes in family income). That makes it tough for people to have continuity of medical care, one of the often-stated sub-goals of Obamacare. Last week we suggested reporters use the Health Affairs study as a starting point for further reporting.

Monday, PBS NewsHourtook a look at the affordability question that has plagued the ACA’s rollout for months. One guest, Mary Agnes Carey from Kaiser Health News, raised the issue, saying people will have to decide if the coverage is affordable. Said Carey: “Some of these policies have fairly high co-pays, out-of-pockets costs, deductibles, and so on…Do people sign up for a premium and they decide, gosh, they just can’t cut it? Maybe the subsidies don’t help them enough. Maybe they do.” It would have been helpful for host Judy Woodruff to distinguish for her audience the difference between affordable premiums and affordable medical care which, for many families, will be a function of how much cost-sharing the policy requires. Reporters tend to interchange the two concepts, which makes it hard for people to understand the point being made.

Another thread running through coverage: Who’s left out. Karen Garloch of the Charlotte Observerwrote mini-profiles of people in caught in Medicaid’s coverage “gap”—an area of overall press neglect, as we’ve noted. In fact, much of the coverage from other outlets in our sample used people anecdotes to illustrate the points they were making. Reuters presented dueling anecdotes to illustrate that “major hurdles remain” for the law: a newly-insured waitress and healthcare reform advocate in Georgia who was “scared constantly” when she didn’t have insurance, and a 57-year-old woman in North Carolina who lost her employer insurance last year and worries that an out-of-pocket maximum of $5,000 on the new policy will put her medicines out of reach. The interview with the waitress, Reuters disclosed, was arranged by Consumers Union, which it described as “a public advocacy group that sees Obamacare as a benefit to consumers.” The office of Rep. Renee Ellmers, a North Carolina Republican and Obamacare opponent, helped arrange the interview with the second woman, Reuters noted. We were pleased to see these disclosures—which we’ve been calling on reporters to make. They provided context for readers to understand what these women were saying.

One big omission I noted in my scan of coverage was the failure of some outlets to place the actual number of sign-ups in the larger picture, such as how many will continue to be uninsured and how many were uninsured when the law was passed. Bloomberg was one exception, noting, “The CBO, which estimates that 45 million Americans will be uninsured this year despite the law, says that the number will only shrink as far as 31 million by 2024, the 11th year of expanded coverage.” Numbers such as these help audiences assess how well the law is doing its intended job—insuring many more Americans.

As the next phase of Obamacare unfolds, here are some areas for journos to investigate:

• Will patients be able to afford their care? Affordability of care and affordability of insurance are big ones to watch. Obamacare cements in place The Great Cost Shift from insurers and employers to patients, which has been in the making for more than a decade now. The Democrats talk about adding a “copper” plan to the coverage already offered on the exchanges. Presumably, these “copper” plans will cover less than the “bronze” plans which cover only 60% of a person’s medical expenses. That would shove even more cost onto the policyholders. Whether this gets legislative traction is something for reporters to watch.

• Do people whose incomes are just over the line and not eligible for subsidies or those eligible for reduced cost sharing (available for people whose incomes are below 250 percent of poverty or $59,625 for a family of four) understand what’s happening? Will there be a backlash? Obamacare further bakes in the inequalities that exist in the US healthcare system. The law makes these inqualities more transparent with the different options offered on the exchanges.

• Will hospitals, the biggest source of costs in the system, continue on their march to greater market power with little regulation? As hospitals and insurers duke it out, patients may pay the price.

• Will states or the federal government fix the consumer hassles people are discovering with their new policies? Who do they complain to? What if they’re caught in the middle of a dispute, as patients in New Jersey were?

Perhaps the biggest question of all to keep in mind is what kind of healthcare system do we want and who is it for?

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